Contextual Assessments Research Articles

Travelmate: Connecting Travellers with Local Guides

Abstract—The tourism sector is booming, with a huge number of people traveling globally each year. The local escort is one of the essential elements that contribute to a positive travel industry experience. After some time, customary local specialists evolved essentially by combining various media and innovations to improve the guest’s understanding. This study explores the history of local escorts, examines the role that innovation has in shaping local escorts today, and discusses innovative approaches to improving encounters with the tourist sector. This study aims to provide tidbits of information on how creative local escorts can transform the tourism business and make it more vivid and connect with experiences for travelers by evaluating existing literature and contextual assessments. Index Terms—Tourism, application, development, business, experiences, information

The ethics of enhancement among image and performance enhancing drug coaches

ABSTRACT This research examines image and performance-enhancing drug (IPED) use, specifically focusing on the emerging role of IPED coaches. Situating drug use within broader assemblage theory, we investigated how these coaches, often operating in an online context, function as enabling environments, influencing practices, and contributing to harm reduction in a broader social context within and for IPED communities. Ten IPED coaches were interviewed, with this work focusing on their legal, ethical, and moral considerations, risk assessment, and harm reduction strategies of their practices. We employed a critical realist approach, following flexible coding to identify and develop themes which were further framed an enabling environments framework. Coaches operated along an ethical tightrope, emphasising the conscious regulation of conduct within established norms and the nuanced assessment of risks aligned with individual goals and motivations. Power dynamics and responsibility concerns unfolded through the lens of collaborative decision-making, where trust emerged as an essential element of these relations within contextual risk assessments. IPED coaches play a role in harm reduction by fostering trust and informed decision-making, balancing clients’ goals with health considerations. These findings emphasise the potential for collaboration between IPED coaches and the health workforce to enhance health promotion and support within IPED communities.

Characterizing Life Stress Exposure Among Sexual Minority Adolescents: Temporality, Content, And Mediating Role in Mental Health Disparities.

Though sexual minority adolescents face a wide array of deleterious stressors, few studies have examined the role of specific types of stress exposure (i.e., chronic vs. episodic, interpersonal vs. non-interpersonal) on mental health disparities. This study utilizes a contextual threat-based assessment to (a) compare levels of stress exposure types between sexual minority and non-sexual minority adolescents, and (b) examine stress type as a mediator between sexual orientation and two outcomes: depressive symptoms and emotion dysregulation. Data comes from a longitudinal sample (14-17years-old, N = 241; 17.6% sexual minority; 54% assigned female at birth; 73.9% White), with two time-points (T1 and T2) utilized. Sexual minority adolescents reported higher chronic interpersonal stress, but no differences in non-interpersonal chronic or episodic stress, relative to non-sexual minority adolescents. Chronic interpersonal stress exposure mediated the link between membership in an oppressed group (i.e., sexual minority teens) and the primary outcomes (emotion dysregulation and depressive symptoms) at both T1 and T2. Findings demonstrate the utility of contextual threat-based assessments within sexual minority research.

A clinician's guide to the 2023 VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder.

A clinical practice guideline (CPG) is a rigorously established set of recommendations based on currently available evidence about the efficacy, safety, acceptability, and feasibility of interventions to assist with clinical decision-making. The 2023 Department of Veterans Affairs /Department of Defense Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder is described herein. The CPG recommendations are accompanied by a clinical algorithm, which incorporates principles of evidence-based practice, shared decision-making, and functional and contextual assessments of goals and outcomes. An overview of the CPG recommendations is combined with a discussion of questions that clinicians and patients may face in implementing the CPG and suggestions for how to effectively work with the CPG.

Study protocol for the development of a real-time interface showing the availability of breast and cervical cancer services in Ghana.

The 5-year survival rates for breast and cervical cancers in Ghana are low in comparison to rates in developed countries. This striking disparity is attributed to numerous factors, including limited access and navigability to appropriate services. A one-time cross-sectional, hospital-based survey was performed by the University of Utah in collaboration with Ghana Health Services (GHS) and Health Facilities Regulatory Agency (HeFRA) from November, 2020 to October, 2021 so as to determine existing hospital-based breast and cervical cancer care services capacity and their geographic availability nationwide. This related information remains dynamic in nature and time. The current project employs a public-academic implementation science and research configuration to explore and develop a real-time interface (RTIF) showing the availability of breast and cervical cancer care services at hospital facilities in-country so as to anchor up-to-date data products for the government, private-sector, and patient-centric consumption. Multiple methods will be employed to achieve the study objectives between December 2023 to November 2024. The first three objectives shall focus on contextual, needs, and feasibility assessments guided by the domains and constructs within the updated Consolidated Framework for Implementation Research (CFIR) during coding and thematic qualitative analysis. Using purposive sampling, breast and cervical cancer care service stakeholders shall be identified for individual in-depth interviews. The fourth objective will involve creating the RTIF prototype and piloting it in the Eastern Region of Ghana. The final and fifth objective shall employ the systems usability scale (SUS) amongst ten randomly selected individual stakeholders to assess the technical functionality of the interface. A nationwide scale-up shall follow this.

2022 APTA Pediatrics Knowledge Translation Lecture: Clinicians and Researchers Collaborate to Implement a Segmental Approach to Trunk Control.

The aim of this special communication is to describe a clinician/researcher collaboration that supported implementation of the segmental approach to trunk control into physical therapy practice at a large, multisite, pediatric hospital. A 6-phase, multifaceted iterative process including use of educational strategies, the knowledge-to-action (KTA) cycle, the Consolidated Framework for Implementation Research, and the Theoretical Domains Framework was used. The total number of Segmental Assessments of Trunk Control (SATCos) completed increased from 0 to 57. Fifteen of 23 physical therapists representing 7 clinic locations referred a child for a SATCo. Using education alone or education plus the KTA cycle resulted in minimal uptake. Using more formal contextual assessments and mapping of barriers to strategies using implementation frameworks, collaborative goal setting, and planning resulted in more effective strategies and increase in uptake of the segmental approach in later phases.

WHO Global Situational Alert System: a mixed methods multistage approach to identify country-level COVID-19 alerts

BackgroundGlobally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed...

Land Degradation–Desertification in Relation to Farming Practices in India: An Overview of Current Practices and Agro-Policy Perspectives

Land degradation and desertification (LDD) has gained worldwide policy attention due to decline in land quality and the resultant economic burden accrued upon a vast population reliant on land-based natural capital. In India, the impacts are becoming apparent as 24 out of 29 states have been experiencing LDD since the early 2000s. Here, we adopt a mixed-method approach combining hierarchical cluster analysis (HCA) and multilinear regression analysis (MLRA) with contextual assessments to draw on, using state-level information from 2011–2013, an age-old question: do farming operations aggravate LDD? The HCA identified 11 states that currently lead the trajectory with the highest state-wise percentages of LDD areas under ‘water erosion’, ‘salinity’, and ‘water logging’, which are the three most widely reported impacts of farming practices on land systems’ sustainability as apparent in the relevant LDD literature. MLRA of the 11-state cluster revealed that state-wise NPK fertilizer-application rates (p < 0.01); number of moldboard ploughs (p < 0.01); net irrigated area (p < 0.01); groundwater-sourced irrigation (p < 0.05); and multiple cropping practices (p < 0.01) exacerbate LDD, while bio-pesticides (p < 0.05) and zero-till drills (p < 0.01) do the opposite. In recent years, the government has introduced several improved measures, such as nutrient-based subsidies (NBS) and integrated nutrient management (INM), to help farmers optimize agrochemical applications, thus moving from traditional practices (input intensive) to a more land-conservation-centric approach. However, at the cognitive level, farmers are unsure/unaware of the benefits. Moreover, due to various institutional weaknesses, lack of sensitization, extension services, capacity building, incentives, and certain inherent flaws in these newer strategies, their uptake remains low, while traditional practices continue at the grassroots. We attempt to broaden the regulatory purview by reflecting on the DPSIR framework (Driver–Pressure–State–Impact–Response), highlighting the role of indirect drivers of LDD that largely influence farmers’ preferences for certain practices. In the final section, we emphasize the need for a data revolution to support process-level research to be able to devise more informed and targeted LDD control–abatement strategies, which is currently largely absent.

Contextual uncertainty assessments for InSAR-based deformation retrieval using an ensemble approach

InSAR and associated analytic methods enable relative surface deformation measurements from low Earth orbit with a potential accuracy of centimeters to millimeters. However, assessing the actual accuracy can be quite difficult. The analytic methods are complicated enough that naïve analytic error propagation is infeasible, and, in many settings, InSAR practitioners lack sufficient ground truth to assess results. Phase noise due to partial decorrelation from changes in the scattering properties of the ground is a prominent source of accuracy loss. In this paper we present a method to assess the loss of precision due to this component of phase noise. The proposed method consists of generating synthetic data stacks whose statistical properties match those of the actual input SAR data stacks, and then using the synthetic data for an ensemble calculation. The spread of the results of the ensemble calculation indicates the loss of precision. We show examples of the ensemble analysis at a mining operation in South Africa, and demonstrate the ability to estimate the precision of two InSAR deformation retrieval methods on a point-by-point and epoch-by-epoch basis.

Variables shaping participatory constitution-making: Insights from the experiences of small states

Abstract One of the assumptions that undergirds, sometimes implicitly, much of the contemporary push for participatory constitution-making is that meaningful popular involvement is easier to achieve in units with fewer inhabitants. This article critically interrogates that view, using the experience of small states (understood as those with no more than 1.5 million inhabitants) during constitution-making processes. It suggests that population size is not always a decisive or even significant variable when it comes to the type and quality of popular input realized during constitution-making in small states. Instead, five other macrocultural and environmental variables that, either alone or together, may have a greater impact are identified: democratic history and elite stewardship; the enduring presence of traditional orderings of society and approaches to governance; the ethnic and religious make-up of society; the available human capital and state of economic development; and physical geography. Drawing on case studies from the Asia-Pacific region, we show how these variables play out and highlight the need for contextual assessments of participatory constitution-making, also within the small state universe, to avoid falling into the “usual suspect” trap that has long plagued work in comparative constitutional law generally. This article further suggests that the relevance of the five variables mentioned does not appear to be peculiar to small states, which means that these variables can similarly be profitably used in studies of participatory processes generally.

Use of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to guide iterative adaptations: Applications, lessons learned, and future directions.

Implementation science frameworks have been used widely for planning and evaluation, but seldom to guide adaptations during program implementation. There is great potential for these frameworks to be used to inform conceptual and data-driven decisions about adaptations. We summarize recent applications using Iterative RE-AIM to capture and guide adaptations. Iterative RE-AIM can be repeated at multiple time points customized to each project and involves the following activities: identification of key implementation partners; rating importance of and progress on each RE-AIM dimension (reach, effectiveness, adoption, implementation, and maintenance); use of summary data on ratings to identify one or two RE-AIM dimensions for adaptations and implementation strategies; and evaluation of progress and impact of adaptations. We summarize recent and ongoing Iterative RE-AIM applications across multiple care coordination and pain management projects within the Veterans Health Administration, a hypertension control trial in Guatemala, a hospital-based lung ultrasound implementation pilot, and a colorectal cancer screening program in underserved communities. Iterative RE-AIM appears feasible, helpful, and broadly applicable across diverse health care issues, interventions, contexts, and populations. In general, the RE-AIM dimension showing the largest gap between importance and progress has been Reach. The dimensions most frequently selected for improvement have been Reach and Implementation. We discuss commonalities, differences and lessons learned across these various applications of Iterative RE-AIM. Challenges include having objective real time data on which to make decisions, having key implementation staff available for all assessments, and rapidly scoring and providing actionable feedback. We discuss print and online resources and materials to support Iterative RE-AIM. The use of Iterative RE-AIM to guide and support understanding of adaptations has proven feasible across diverse projects and in multiple case studies, but there are still questions about its strengths, limitations, essential components, efficiency, comparative effectiveness, and delivery details. Future directions include investigating the optimal frequency and timing for iterative applications; adding contextual assessments; developing more continuous and rapid data on which to make adaptation decisions; identifying opportunities to enhance health equity; and determining the level of facilitation that is most cost-effective.

Understanding Behavior in Phelan-McDermid Syndrome.

BackgroundPhelan-McDermid syndrome (PMS) or 22q13.3 deletion syndrome is a rare genetic disorder characterized by developmental delay, hypotonia and severely delayed speech. Behavioral difficulties are often reported in PMS, although knowledge of behavioral profiles and the interpretation of reported behavior remains limited. Understanding the meaning of behavior requires considering the context as well as other domains of functioning, for example the individual's level of cognitive, social and emotional development. Combining structured direct in-person neurodevelopmental assessments with contextual assessments to enable meaningful interpretations of reported behavior on functional dimensions across multiple units of analysis, as proposed by the RDoc framework, is essential.MethodsIn this article we present a structured multidisciplinary method of assessment through direct in-person neurodevelopmental assessments and assessment of contextual factors. Our study sample includes data of 33 children with an average age of 6.2 years (range 1.1 to 15.7) with PMS, obtained through individual in-person assessments in combination with parent informed questionnaires. We assessed developmental age using the Bayley-III, adaptive behavior was assessed with the Vineland screener, social-emotional development with the ESSEON-R and behavior by using the CBCL.ResultsOur results show a great deal of variability in phenotypic presentation with regard to behavior, symptom expression and symptom severity in individuals with PMS. The data on behavior is interpreted in the context of the individual's level of cognitive, adaptive development and the (genetic) context. Behavioral data showed high levels of withdrawn behavior and attention problems. More than half of the children showed borderline or clinical symptoms related to Autism Spectrum Disorder (ASD).ConclusionsThe interpretation of the meaning of certain behavior in PMS is often based on questionnaires and descriptions without taking the specific context of development into account. Combining questionnaires with direct in-person assessments measuring different domains of functioning should be considered a more accurate method to interpret the meaning of findings in order to understand behavior in rare genetic disorders associated with developmental delay such as PMS. Direct in-person assessment provides valuable and specific information relevant to understanding individual behavior and inform treatment as well as increase knowledge of the neurodevelopmental phenotype in individuals with PMS. More specific application of the proposed frameworks on behavior in PMS is desirable in making useful interpretations.

Influence of measurement type and the moment of occurrence of low performance behaviour's on task and citizenship performance appraisal

This research studies whether the moment of occurrence of a task or contextual behaviour with a low performance produces a primacy or recency effect and whether it causes changes in performance appraisal. We also analyzed whether the nature of assessment questionnaire items affects raters’ assessments and how the sequence of questionnaire presentation and completion may do so. Participants were 146 undergraduate students. We used a design with two inter-subject variables (questionnaire presentation and performance sequence) and one within-subject variable (global versus specific questionnaires). Findings show that if a low performance is presented at the beginning of the assessment period, the performance assessment will be more negative. Also, results indicate that task performance appraisals and contextual behaviour assessments are higher and less accurate when performed with a questionnaire that includes global items.

Electrical Components Involved in Avian-Caused Outages in Iran

SummaryAvian electrocutions are a global conservation problem. Power outages associated with electrocutions are problematic for electric utilities focused on delivering reliable electric power. We used contextual data, photographs, line voltage, outage type and assessments of power line components to quantify outage-causing avian electrocutions throughout each of Iran’s 31 provinces. We evaluated records of 222 avian-caused outages involving 235 electrocuted birds in 2018. Of these, 14.5% involved species of conservation concern, and a few (at least eight) sparked fires when the plumage of electrocuted birds ignited and fell into dry vegetation. Most avian-caused outages (96%) involved distribution voltages, and 91% involved phase-to-ground contacts attributable to grounded concrete pylons with grounded steel crossarms. These are the most common type of power line structure in Iran. Insulators were involved in 37% of outage-causing avian electrocutions, fused cutouts 29%, transformers 33%, and midspan collisions 1%. Given the numbers of these components in the electrical system, fused cutouts and transformers were involved in more outage-causing avian electrocutions than expected due to chance. The average body size of electrocuted birds was largest for incidents involving suspension insulators, smaller for birds electrocuted on other insulators, and smallest for electrocutions on fused cutouts and transformers. Given that most avian electrocutions do not cause outages and given the similarity across electric systems in the region, our findings likely indicate a much larger avian electrocution concern throughout the middle east. Retrofitting power line components to reduce avian contacts would reduce impacts to wildlife and improve the electrical system’s reliability, reduce costs associated with unplanned outages, and reduce risks associated power line ignitions of fires.

Accuracy of Sedentary Behavior-Triggered Ecological Momentary Assessment for Collecting Contextual Information: Development and Feasibility Study.

BackgroundSedentary behavior has received much attention in the scientific community over the past decade. There is growing evidence that sedentary behavior is negatively associated with physical and mental health. However, an in-depth understanding of the social and environmental context of sedentary behavior is missing. Information about sedentary behavior, such as how everyday sedentary behavior occurs throughout the day (eg, number and length of sedentary bouts), where, when, and with whom it takes place, and what people are doing while being sedentary, is useful to inform the development of interventions aimed at reducing sedentary time. However, examining everyday sedentary behavior requires specific methods.ObjectiveThe purpose of this paper is (1) to introduce sedentary behavior–triggered Ecological Momentary Assessment (EMA) as a methodological advancement in the field of sedentary behavior research and (2) to examine the accuracy of sedentary behavior–triggered EMA in 3 different studies in healthy adults. Moreover, we compare the accuracy of sedentary behavior–triggered EMA to simulations of random-trigger designs.MethodsSedentary behavior–triggered EMA comprises a continuous assessment of sedentary behavior via accelerometers and repeated contextual assessments via electronic diaries (ie, an application on a smartphone). More specifically, the accelerometer analyzes and transfers data regarding body position (a sitting or lying position, or an upright position) via Bluetooth Low Energy (BLE) to a smartphone in real time and triggers the deployment of questionnaires. Each time a participant spends a specified time (eg, 20 minutes) in a sedentary position, the e-diary triggers contextual assessments. To test the accuracy of this method, we calculated a percentage score for all triggered prompts in relation to the total number of bouts that could trigger a prompt.ResultsBased on the accelerometer recordings, 29.3% (5062/17278) of all sedentary bouts were classified as moderate-to-long (20-40 minutes) and long bouts (≥ 41 minutes). On average, the accuracy by participant was 82.77% (3339/4034; SD 21.01%, range 71.00-88.22%) on the study level. Compared to simulations of random prompts (every 120 minutes), the number of triggered prompts was up to 47.9% (n=704) higher through the sedentary behavior–triggered EMA approach. Nearly 40% (799/2001) of all prolonged sedentary bouts (≥ 20 minutes) occurred during work, and in 57% (1140/2001) of all bouts, the participants were not alone.ConclusionsSedentary behavior–triggered EMA is an accurate method for collecting contextual information on sedentary behavior in daily life. Given the growing interest in sedentary behavior research, this sophisticated approach offers a real advancement as it can be used to collect social and environmental contextual information or to unravel dynamic associations. Furthermore, it can be modified to develop sedentary behavior–triggered mHealth interventions.

The three-stage assessment to support hospital-home care coordination in Tshwane, South Africa.

BackgroundIn complex health settings, care coordination is required to link patients to appropriate and effective care. Although articulated as system and professional values, coordination and cooperation are often absent within and across levels of service, between facilities and across sectors, with negative consequences for clinical outcomes as well as service load.AimThis article presents the results of an applied research initiative to facilitate the coordination of patient care.SettingThe study took place at three hospitals in the sub-district 3 public health complex (Tshwane district).MethodUsing a novel capability approach to learning, interdisciplinary, clinician-led teams made weekly coordination-of-care ward rounds to develop patient-centred plans and facilitate care pathways for patients identified as being stuck in the system. Notes taken during three-stage assessments were analysed thematically to gain insight into down referral and discharge.ResultsThe coordination-of-care team assessed 94 patients over a period of six months. Clinical assessments yielded essential details about patients’ varied and multimorbid conditions, while personal and contextual assessments highlighted issues that put patients’ care needs and possibilities into perspective. The team used the combined assessments to make patient-tailored action plans and apply them by facilitating cooperation through interprofessional and intersectoral networks.ConclusionEffective patient care-coordination involves a set of referral practices and processes that are intentionally organised by clinically led, interprofessional teams. Empowered by richly informed plans, the teams foster cooperation among people, organisations and institutions in networks that extend from and to patients. In so doing, they embed care coordination into the discharge process and make referral to a link-to-care service.

The social context of substance use among older adults: Implications for nursing practice.

AimThe purposes of this paper are (a) to critically analyse the social context of substance use among older adults and (b) to offer strategies for nurses and other health care providers to support the health of older adults experiencing problematic substance use.DesignDiscussion paper.MethodsThis analysis is informed by two theoretical lenses: an intersectional lens in examining the various factors influencing health and health care access; and a social justice lens, focusing on promoting health equity for older populations.ResultsAs a result of various social and sociopolitical factors, key issues are likely to arise for older adults experiencing problematic substance use including health and social inequities, stigma, and discrimination, all of which can result in serious negative health outcomes. Health care providers can help mitigate these effects by (a) promoting harm reduction principles; (b) participating in social justice actions; and (c) engaging in contextual assessments of substance use.

Using ethnography in politeness studies: A discursiveness-based approach

The current study points out the methodological limitations of contemporary discursive politeness research and suggests that in-depth ethnographic data provides a potentially crucial solution. Discursive politeness studies advocate a data-driven, bottom-up analytical approach that stresses the importance of participants’ own contextual assessments. Analysis of such kind requires the corresponding methodological design which allows researchers to obtain the defining information that can be seemingly absent in the on-going interaction. However, in the current body of literature, politeness research focuses on theoretical discussion without specifically organised consideration regarding methodology. Therefore, aiming at providing a more valid methodological approach, the current study proposes to consider ethnography as the foundational data-collection method for discursive politeness research, stressing ‘long-term’ and ‘in-depth’ as the core features in conducting fieldwork. In order to clarify this view, the current study demonstrates a case study via examining an interaction naturally occurring among several family members during dinner time in China. This interaction is examined on two levels respectively (i.e., based on demographic data and in-depth ethnographic data). This paralleled analysis reveals that in complicated real-life interactions, lacking of thorough contextual information of both cultural norms and individually shaped cognition can be misleading in analysis. Therefore, understanding (im)politeness as an interactionally situated contextual/cognitive judgement, long-term ethnography is needed and that the fieldwork should be conducted carefully and patiently in order to gain access to comparatively more solid data and achieve more valid conclusion.

Bog Bodies in Context: Developing a Best Practice Approach

Bog bodies are among the best-known archaeological finds worldwide. Much of the work on these often extremely well-preserved human remains has focused on forensics, whereas the environmental setting of the finds has been largely overlooked. This applies to both the ‘physical’ and ‘cultural’ landscape and constitutes a significant problem since the vast spatial and temporal scales over which the practice appeared demonstrate that contextual assessments are of the utmost importance for our explanatory frameworks. In this article we develop best practice guidelines for the contextual analysis of bog bodies, after assessing the current state of research and presenting the results of three recent case studies including the well-known finds of Lindow Man in the United Kingdom, Bjældskovdal (Tollund Man and Elling Woman) in Denmark, and Yde Girl in the Netherlands. Three spatial and chronological scales are distinguished and linked to specific research questions and methods. This provides a basis for further discussion and a starting point for developing approaches to bog body finds and future discoveries, while facilitating and optimizing the re-analysis of previous studies, making it possible to compare deposition sites across time and space.

Enhancing feasibility: Incorporating a socio-ecological systems framework into restoration planning

Forest restoration is the counterforce to deforestation. In many parts of the world it mitigates forest loss and degradation, but success rates vary. Socio-political variables are important predictors of effectiveness of restoration activities, indicating that restoration strategies need to be locally adapted. Yet, contextual assessments of the biophysical, social and political characteristics of forest restoration are rare. Here, we integrate a social-ecological systems framework with systematic decision-making to inform forest restoration planning. We illustrate this approach through a prioritization analysis in a community-based forest restoration context in Paser District, East Kalimantan, Indonesia. We compare the solutions of our integrated framework with those identified on the basis of biophysical criteria alone. We discover that incorporating a socio-political context alters the selection of priority areas. While the social feasibility and political permissibility can be enhanced, ecological benefits are likely to be reduced and/or opportunity costs of alternative land uses are to be increased. Our conceptual framework allows the appraisal of potential trade-offs between social and ecological outcomes of alternative options, and has the potential to evaluate the efficiency of existing policies. Empirical testing in a range of contexts is required to ensure broad applicability and transferability of our conceptual framework.